Provider Demographics
NPI:1366699084
Name:ZOLTACK, TODD MICHAEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:MICHAEL
Last Name:ZOLTACK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8931
Mailing Address - Country:US
Mailing Address - Phone:484-526-3000
Mailing Address - Fax:484-526-3030
Practice Address - Street 1:153 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8931
Practice Address - Country:US
Practice Address - Phone:484-526-3000
Practice Address - Fax:484-526-3030
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002271363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant